Benefit of cytostatic therapy in 3rd and following line in metastatic breast cancer

Abstract

742 Background: A variety of cytostatic substances are effective in the treatment of metastatic breast cancer. Most substances have been evaluated in clinical studies as first- or second-line therapy, and occasionally as third-line therapy. However, patients (pts.) with progressive disease after second line therapy and good performance status might receive further treatment. Known pathomechanisms and clinical experience support the assumption that tumors which progress during chemotherapy are more likely to be resistant to following therapies, but clinical studies are not available. The aim of this retrospective study was, to evaluate the effect of third- to seventh-line cytostatic therapy. Methods: 120 patients with metastatic breast cancer with at least three cytostatic therapies from 1991 to 2004 were included. Median age at first diagnosis of breast cancer was 51 years (27–76), 64% of the tumors were hormone receptor positive. 58% of the patients had received (neo-) adjuvant cytostatic therapy. Therapies were evaluated with respect to response, time to treatment failure (TTF) and toxicity WHO III° and IV°. Results: Of 120 patients, 120 received three, 99 four, 63 five, 31 six and 21 seven consecutive cytostatic regimens. Mainly used cytostatic substances were (descending frequency): anthracyclines, taxanes, vinca alcaloids, alkylating agents, capecitabine or 5-fluoruracil, gemcitabine and trastuzumab. Response rates, TTF and toxicity rates are shown in table 1. Conclusions: Clinical benefit for patients with metastatic breast cancer is possible even after several preceding cytostatic therapies. High grade toxicity is rare. Thus, further therapy for those patients can be acceptable in individual situations. No significant financial relationships to disclose.